Vertebral Augmentation For Osteoporotic Spine Fractures

By Author: Dr. Swati Bhat MD & Director (IPSC, South Zone)
Total Articles: 10
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Dr. Swati Bhat
MD & Director (IPSC, South Zone)
Consultant, IPSC Bengaluru
Academic Head, IPSC Varsity and Training Institute
Neuro- Spine Interventional and Pain Specialist

What is osteoporosis?
Osteoporosis is a condition in which the bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D. Most often it happens as we age.

How does osteoporosis lead to spine compression fractures?
Compression fractures are tiny breakages in the bones in our spine. As we age these bones are more likely to break due to loss of minerals that give strength to the bone. Over time, breaks in the spine bones cause its collapse ,called as compression fracture.

What is the difference between compression fracture of spine and wedge compression ?
Compression fracture is commonly caused by osteoporosis. A compression fracture causes a collapse in the spine bone and typically results in a reduction of vertebral height around up to 20% because of the fracture and can happen in any area of the spine but most ...
... commonly occurs in the thoracic spine. A wedge compression is the most common type of fracture which involves the front part of the vertebral spine where the rest of the spine is unaffected as it is considered mechanically stable without causing any spinal cord damage.

Why osteoporotic fractures don’t heal on their own?
Osteoporotic patients differ from normal population as they have poor bone quality due to mineral composition, content, and crystallinity. This could be lack of growth factors, and framework cells, and agents promoting bone formation and bone strength .Due to these reasons fracture healing in osteoporosis becomes a complex process of bone regeneration where healing does not happen the way it happens in normal healthy individuals and fractures may take longer time to heal or may not heal at all.

What is diff b/w vertebroplasty and kyphoplasty and which is safe ?
Vertebroplasty is a procedure where the doctor injects the cement into the cleft or the space created by the fracture. This is achieved by taking several shots under the x-ray guidance called fluoroscope that helps to visualize the extent and spread of the cement with in the spine bone. kyphoplasty is also undertaken to correct the fracture with a technical difference that there is a mesh with in the needle used for cement injection which is targeted towards the fracture and expands as the cement is filled inside

What is the success rate of vertebroplasty ?
Vertebroplasty has more than 90% success rate to relieve pain , which happens almost instantly after the procedure. However it may vary slightly depending on how many fractures are present and factors like presence of other spine conditions. In long standing cases, other areas of the spine also start generating pain. In such cases, pain relief is significant immediately after the procedure but it may take some additional time to relieve the pain of muscles and the joints.

My fracture is an old fracture. Can I still undergo vertebroplasty?
Usually vertebroplasty should be performed with in 1 to 2 months of an acute fracture . However, MRI scans can reveal the condition of an older fracture that needs or may benefit from vertebroplasty.

How long does it take to heal from vertebroplasty and kyphoplasty?
Both vertebroplasty and kyphoplasty can be done percutaneously which means through skin, not requiring any surgical incision, cutting of muscles or bones and causing any blood loss. The patient can walk back home the same day of the procedure. The Interventional pain specialist performing the intervention will brief you on the Do’s and Do Not’s after the procedure in the immediate post procedure days.

What can you not do after vertebroplasty ?
You may be advised to lie down in the bed after the procedure not allowing you to sit upright for 4-5 hrs. Bending or twisting the spine is avoided in the immediate recovery period for few days .Lifting heavier objects is also avoided.

I have a spine metastasis. Can vertebroplasty cure my cancer spread?
Some cancers, such as lung, breast and thyroid cancer, often metastasize to the bones and spine leading to pain and collapse of the bones. In such patients, thermal ablation methods such as radiofrequency, microwave or cryoablation can be applied to the metastasis mass first, then vertebroplasty is performed through the same needle. The pain-reducing effects of both ablation and vertebroplasty may be increased when used together. But vertebroplasty cannot cure or stop the spread of cancer cells which may have its primary cancer source elsewhere.

How Painful is the procedure?
A percutaneous vertebroplasty can be a painful procedure but the procedure is performed under local anesthetic given at the skin deep down upto the bone where the fracture is to be corrected. This makes this extremely painless and safe as the risk of anesthesia is totally avoided.

Is vertebroplasty safe for elderly ?
Yes , it is completely safe for the elderly to undergo vertebroplasty .Elderly patients often have comorbid conditions like diabetes, hypertension, cardiovascular and cognitive problems which may make anesthesia extremely challenging requiring icu stay, prolonged hospitalization and recovery , but all of this can be avoided by doing percutaneous vertebroplasty .

What are the side effects after vertebroplasty?
Cement leak is one of the complications which can be avoided by making proper assessment of the fracture before doing the procedure. This is often done by carefully examining the patient and checking the scans thoroughly , and maintaining caution during the cement injection .Minor complications like bleeding and infection can be avoided in almost all patients by following standard protocols before any intervention major or minor.

Can I go back home after vertebroplasty?
Yes after checking your vital stability , you may go back home the same day of the procedure or the morning after.